Lessons Learned From State-Based Efforts to Leverage Medicaid Funds for Graduate Medical Education
Erin P Fraher1, Jacob A Rains2, Thomas J Bacon3
1E.P. Fraher is professor, Department of Family Medicine, University of North Carolina at Chapel Hill, and deputy director for policy, Cecil G. Sheps Center for Health Services Research, Chapel Hill, North Carolina.
Purpose:
Total Medicaid funds invested in graduate medical education (GME) increased from $3.78 billion in 2009 to $7.39 billion in 2022. States have flexibility in designing Medicaid GME payments to address population health needs. This study assessed states' impetus for using Medicaid funds for GME, structure of state Medicaid payments, composition and charge of advisory bodies that guide these investments, and degree of transparency and accountability to track whether Medicaid GME investments achieved desired workforce outcomes.
Method:
Structured interviews were conducted in 2015 to 2016 and 2020 to 2021 with subject matter experts representing 10 states. Interview transcripts were analyzed and coded in 6 thematic areas: impetus for using Medicaid funds, the structure of state Medicaid payments, the composition of advisory bodies, the degree of transparency of Medicaid investments, accountability of Medicaid investments, and challenges.
Results:
States used Medicaid GME funding to address maldistribution of physicians by geography, setting, and specialty; respond to population growth and undergraduate medical education expansion; offset potential loss of teaching health center program funds; and launch new programs and sustain existing ones. States leveraged Medicaid funding by modifying state plan amendments and redesigning funding formulas to meet specific health workforce needs. Many states had advisory bodies to educate legislators, reach consensus on workforce needs, recommend how to disburse funds, and navigate competing stakeholder interests. States identified a need for improved data and analytic systems to understand workforce needs and monitor the outcomes of GME investments. Determining which accountability measures to use and implementing metrics were challenges.
Conclusions:
States have much to learn from each other about strategies to best leverage Medicaid funds to develop and sustain residency programs to meet population health needs. Learning collaboratives should be developed to provide a forum for states to share best practices and strategies for overcoming challenges.
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